This invention relates generally to a method for joining bodily tissue in surgical applications and wound repair, and more particularly to a surgical suturing method for joining bodily tissue using a suture having a plurality of barbs which permit the suture to be pulled through the tissue in one direction but resisting movement of the suture relative to the tissue in the opposite direction.
Surgical or accidental wounds are typically closed with a length of filament introduced into the tissue by a sharp metal needle attached to one end of the filament. This device is known as a xe2x80x9csuturexe2x80x9d. Sutures are used to make xe2x80x9cstitchesxe2x80x9d to close the wound for holding tissues together for healing and regrowth. Sutures are used in surgical procedures for wound closure, to close the skin in plastic surgery, to secure damaged or severed tendons, muscles or other internal tissues, and in microsurgery on nerves and blood vessels. Generally, the suture needle is caused to penetrate and pass through the tissue pulling the suture through the tissue. The opposing faces of the tissue are then moved together, the needle is removed, and the ends of the suture are tied in a knot. The suture forms a loop as the knot is tied. The knotting procedure allows the tension on the filament to be adjusted to accommodate the particular tissue being sutured and control of approximation, occlusion, attachment or other conditions of the tissue. The ability to control tension is extremely important regardless of the type of surgical procedure being performed.
Suturing is a time-consuming part of most surgical procedures, particularly in microsurgery and endoscopic surgery where there is insufficient space to properly manipulate the suture. Loop sutures can leave scars where they penetrate skin. For adequate closure of some wounds, the suture material must be of a high tensile strength and thus a large diameter thereby increasing scarring. The loop suture also constricts blood flow to the tissue it surrounds, promoting necrosis of the wound margins which compromises healing and increases infection risks. Further, the tissue is distorted as it is secured by the suture loop due to excess tension on the knots. Localized tensions from the knots are the culprit for scar formation. The bulk of the knots are also an impediment to wound healing in internal applications.
Alternatives to conventional sutures for wound closure are known, including fasteners such as staples, clips, tacks, clamps and the like. The fasteners are usually positioned transversely across a wound for joining or approximating each side of adjacent tissue layers laterally. Fasteners have relatively high strength and save time, but are not as accurate as sutures and are bulky and may be painful to remove. Fasteners are also generally unsuitable for deeper layers of tissue. Moreover, fasteners do not provide the advantage of adjustable tension obtained by the knotting of a length of suture material.
Surface adhesive tapes and glues are often used on skin to hold small wounds closed to permit healing. However, these products have relatively low tensile strength and are not useful in many situations.
Other techniques proposed include electrical coagulation and lasers. However, no acceptable alternative has been found which offers the advantages of suturing and tying in most surgical procedures.
One possible alternative is a barbed suture. A barbed suture includes an elongated body having one or more spaced barbs projecting from the surface of the body along the length of the body. The barbs are configured to allow passage of the suture in one direction through tissue but resist movement of the suture relative to the tissue in the opposite direction. In wound closure, a barbed suture is passed through tissue at each of the opposed sides of a wound. The wound is closed by pushing the sides of the wound together with the barbs maintaining the sutures in place and resisting movement of the tissue away from this position. The advantage of using barbed sutures is the ability to put tension in the tissue with less slippage of the suture in the wound. The barbed suture spreads out the holding forces evenly thereby significantly reducing tissue distortion. Since knots do not have to be tied, there is a time saving and the elimination of suture knots improves cosmetic effects and promotes wound healing. Barbed sutures also allow better apposition of tissue since the incised or insulted tissues are brought together and secured with almost no movement immediately. Unlike the conventional suturing method wherein tension is applied by pulling on the end of the suture after placement, barbed sutures permit tissue to be approximated and held snug during suturing. This is especially advantageous in closing long incisions. The result is better healing when the tissue levels are harmoniously matched as the cosmetic effect is more pronounced at skin level. Moreover, if there is an accidental breakage of the barbed suture, the wound is minimally disturbed. With conventional sutures, dehiscence would occur.
Despite the advantages offered by barbed sutures, the tensile strength of a barbed suture is less than a loop suture of equivalent size. This is due to the reduced tensile strength resulting from imparting the barb structure onto the body of the suture, which reduces its effective diameter. This limitation is not significant since larger barbed sutures with greater tensile strength can be utilized. However, the conventional methods for introducing barbed sutures into tissue still do not exhibit the same biomechanical performance of looped sutures.
For the foregoing reasons there is a need for a suturing method for joining tissue in surgical applications and wound repair which is efficient and expedites the surgical procedure. Ideally, the new method allows a surgeon to suture in an efficient manner to quickly the approximate tissue with appropriate tension. The new method should preserve blood flow, improve wound healing strength, prevent distortion of the tissue and minimize scarring. The method should also incorporate the self-retaining benefits of the barbed suture with the holding power of conventional suturing methods. A particularly useful method would be utilized in surgical applications where space is limited such as microsurgery, endoscopic or arthroscopic surgery.
It is therefore an object of the present invention to provide a method for joining and holding the sides of wounds or surgical incisions in contact or apposition for healing or regrowth.
Another object of the present invention is to provide a method of suturing having characteristics similar to conventional suturing methods such that a surgeon can use techniques similar to those used for suturing with a needle and a length of suture material.
A further object of the present invention is to provide a method of suturing using a barbed suture.
Still another object of the present invention is to provide a method of suturing useful in endoscopic and arthroscopic procedures and microsurgery.
Still further, an object of the present invention is to provide a method of suturing which minimizes scarring and provides a strong retention force between the joined tissues.
Yet another object of the present invention is to provide an efficient procedure for closing wounds, incisions and severed tissues such as tendons, joint capsules, ligaments, bones, vascular structures, valves, and hollow organs.
According to the present invention there is provided a method for joining and holding closed a wound in bodily tissue to allow tissue healing and regrowth together of the two sides of the wound or reconfiguration in vivo using a barbed suture including sharp pointed ends for penetrating the tissue. The method comprises the steps of inserting the first pointed end of the suture into the tissue at a first side of the wound and pushing the first end of the suture through the tissue until the first end of the suture extends out of the tissue at an exit point in the face of the wound below the surface of the tissue at the first side of the wound. The first end of the suture is pulled out of the tissue for drawing the first portion of the suture through the tissue leaving a length of the first portion of the suture in the tissue between the point of insertion in the first side of the wound and the exit point in the face of the wound at the first side of the wound. The first end is then inserted into the face of the tissue below the surface of the tissue at a second side of the wound and pushed through the tissue until the first end of the suture extends out of the tissue at an exit point on the second side of the wound longitudinally spaced in a first direction from the insertion point in the first side of the wound. The first end of the suture is pulled out of the tissue for drawing the first portion of the suture through the tissue while bringing the two sides of the wound together to a closed position along the first portion of the suture in the tissue and leaving a length of the first portion of the suture in the tissue between the point of insertion in the first side of the wound and the exit point in the second side of the wound. Next, the second pointed end of the suture is inserted into the tissue at one side of the wound and pushed through the tissue until the second end of the suture extends out of the tissue at an exit point in the face of the tissue below the surface of the tissue at the one side of the wound. The second end is pulled out of the tissue for drawing the second portion of the suture through the tissue and leaving a length of the second portion of the suture in the tissue between the point of insertion in the one side of the wound and the exit point in the face of the wound at the one side of the wound. The second end of the suture is inserted into the face of the tissue below the surface of the tissue at the other side of the wound and pushed through the tissue until the second end of the suture extends out of the tissue at an exit point on the other side of the wound longitudinally spaced in a second direction from the point of insertion of the second end of the suture at the one side of the wound. The second end is pulled out of the tissue for drawing the second portion of the suture through the tissue while bringing the sides of the wound together to the closed position along the second portion of the suture in the tissue and leaving a length of the second portion of the suture in the tissue between the point of insertion in the one side of the wound and the exit point in the other side of the wound.
Also according to the present invention there is provided a method for joining and holding closed a wound in bodily tissue to allow tissue healing and regrowth together of the two sides of the wound or reconfiguration in vivo using a barbed suture including sharp pointed ends for penetrating the tissue. The method comprises the steps of inserting a first pointed end of the suture into the tissue at a point laterally spaced from one side of the wound, pushing the suture through the tissue to extend out of the tissue in a first face of the wound and penetrating an opposite second face of the open wound until the point of the suture emerges from the tissue at an exit point laterally spaced from the other side of the wound and longitudinally spaced in a first direction from the point of insertion of the first end of the suture at the one side of the wound. The suture is gripped at the point end and pulled out of the tissue for drawing a first portion of the suture having barbs for resisting movement in the opposite direction through the tissue leaving a length of the first portion of the suture body in the tissue of the wound. The second pointed end of the suture is inserted into the tissue at the point of insertion of the first end at the one side of the wound. The second end is pushed through the tissue to extend out of the tissue at a point in the first face of the wound and penetrating the opposite face of the open wound until the point of the second end emerges from the tissue at an exit point laterally spaced from the other side wound and longitudinally spaced in a second direction from the point of insertion of the second end of the suture at the one side of the wound. The second end of the suture is gripped at the point end and pulled out of the tissue for drawing a second portion of the suture including barbs for resisting movement in the opposite direction through the tissue leaving a length of the second portion of the suture body in the tissue of the open wound.
Further according to the present invention a method is provided for joining and holding closed a wound in tissue using a barbed suture including curved pointed ends. A pointed end is inserted into the tissue below the surface at a first face of the wound and pushed along a curvilinear path until the point of the first end of the suture extends from the tissue at an exit point in the first face of the wound longitudinally spaced in a first direction from the insertion point in the first face of the wound. The first end of the suture is gripped at the point end and pulled out of the tissue for drawing the first portion of the suture including barbs for resisting movement in the opposite direction through the tissue leaving a length of the first portion of the body of the suture in the tissue of the open wound. The first end of the suture is next inserted at a point in the second face of the wound, pushed through the tissue along a curvilinear path until the point end of the suture extends from the tissue at an exit point in the second face of the wound longitudinally spaced in the first direction from the insertion point in the second face of the wound and reinserted in the first face. The previous steps are repeated for advancing longitudinally along the wound in the first direction to one end of the wound. The second pointed end of the suture is then inserted into the tissue at the second face of the wound adjacent the initial point of insertion of the first end of the suture in the first face of the wound and pushed through the tissue along a curvilinear path until the point of the second end extends from the tissue at an exit point in the second face of the wound longitudinally spaced in a second direction from the point of insertion of the second needle in the second face of the wound. The second end of the suture is gripped at the point end and pulled out of the tissue for drawing the second portion of the suture including barbs for resisting movement in the opposite direction through the tissue leaving a length of the second portion of the body in the tissue of the open wound. The second end is next inserted at a point in the first face of the wound and pushed through the tissue along a curvilinear path until the point end of the needle extends from the tissue at an exit point in the first face of the wound longitudinally spaced in the second direction from the exit point of the second needle in the second face of the wound and reinserted in the second face. The previous steps are repeated for advancing longitudinally along the wound in the second direction to the other end of the wound as necessary depending on the size of the wound to close the wound.
Still further according to the present invention, another method for joining and holding closed an open wound in bodily tissue to allow tissue healing and regrowth together of the two sides of the wound using a barbed suture with curved pointed ends is provided. This method includes the steps of inserting the first pointed end of the suture into the tissue at a first face of the open wound adjacent one end of the wound and pushing the first end of the suture through the tissue along a curvilinear path until the point end extends from the tissue at an exit point in the first face of the wound longitudinally spaced from the one end of the wound in a direction toward the other end of the wound. The first end of the suture is inserted into the second face of the open wound and pushed along a curvilinear path until the point end extends from the tissue at an exit point in the second face of the wound longitudinally spaced from the exit point in the first face of the wound toward the other end of the wound. The first end of the suture is gripped at the point end and pulled out of the tissue for drawing the first portion of the suture including barbs for resisting movement in the opposite direction through the tissue leaving a length of the first portion of the suture body in the tissue of the open wound. The end of the suture is entered in the first face of the wound and the previous steps are repeated for advancing longitudinally along the wound in the direction toward the other end of the wound until the other end of the wound is reached. Next, the second pointed end of the suture is inserted into the tissue at the second face of the open wound adjacent the initial point of insertion of the first end of the suture at the one end of the wound. The second end of the suture is pushed through the tissue along a curvilinear path until the point end extends from the tissue at an exit point in the second face of the wound longitudinally spaced from the one end of the wound in a direction toward the other end of the wound. The second end of the suture is then inserted into the first face of the open wound adjacent the exit point of the first end of the suture and pushed along a curvilinear path until the point end extends from the tissue at an exit point in the first face of the wound longitudinally spaced from the point of insertion in the first face of the wound in a direction toward the other end of the wound. The second end of the suture is then gripped at the point end and pulled out of the tissue for drawing the second portion of the suture including barbs for resisting movement in the opposite direction, through the tissue leaving a length of the second portion of the body in the tissue of the open wound, and reinserted into the second face of the wound. The previous steps are repeated for advancing longitudinally along the wound in the direction toward the other end of the wound until the other end of the wound is reached and the remaining second portion of the suture removed.
Yet further according to the present invention, a method is provided for joining two ends of severed internal tissue to allow healing and regrowth together of the ends of the internal tissue in vivo using a barbed suture including curved pointed ends. The internal tissue repair method comprises the steps of inserting the first pointed end of a first suture into one end of the internal tissue and pushing the end through the internal tissue along a curvilinear path until the point of the suture extends from an exit point in a first side of the internal tissue longitudinally spaced from the one end of the internal tissue. The end of the first suture is then inserted into the first side of the internal tissue adjacent the exit point and pushed along a curvilinear path until the point end extends from an exit point in the second side of the internal tissue longitudinally spaced from the insertion point in the first side of the internal tissue. The first end of the suture is gripped at the point end and pulled out of the internal tissue for drawing the first portion of the suture, including barbs for resisting movement of the suture in the opposite direction, through the internal tissue leaving a length of the first portion of the suture in the internal tissue. The previous steps are repeated for advancing the first portion of the suture longitudinally along the internal tissue in the direction away from the one end. The previous steps at the other end of the severed tissue with the second end of the suture.
The methods of the present invention are useful in wound closure and repair of internal tissue such as muscle, tendons and ligaments. The methods can be used in open and closed surgery, including arthroscopic and endoscopic surgery.